Rationing Health Care

Think Progress links to this great article on Health Care Rationing. This is one of the big discussions going on today in our illustrious media. Here's the article by GoozNews on Health:

Rationing of Health Care -- Will It Be Just 15 Minutes of Fame?

by GoozNews ~ 20 Jul 2009 11:09am

One can only hope that Princeton University bioethicist Peter Singer's article in the Sunday New York Times magazine will trigger a mature national discussion about rationing health care resources. When and how should we pay for wildly expensive medical technologies, needlessly complicated end-of-life care, heroic interventions in terminal diseases and the other drivers of ever rising health care costs?

It has already kicked off a healthy discussion on many blogs, including this excellent historical overview of the "R-word" from Bob Wachter on The Health Care Blog. I would be remiss if I also didn't remind readers that Henry Aaron and some of his colleagues at the Brookings Institution have been raising this issue publicly for many years, encapsulated in "Can We Say No?", which came out in 2005. It would have been nice if Singer had at least quoted some of the intellectual sources of his own work.

Since this blog has been a consistent voice for using comparative effectiveness research and applying cost-effectiveness analysis to medical technology as a way of properly rationing limited health care dollars, I will refrain from rethumping the tub. The reality is that rationing has always been with us in the U.S., as Singer points out in his article. We ration through price and through limiting access to care.

The question on the table now is whether it will continue that way. Or will rationing become rational by using the best medical science to ensure that limited resources are used to provide the greatest health for the greatest number. If we continue to ration through price, we will simply be allowing the growing split between rich and poor in the U.S., which is already reflected in the relative ill-health of the lower classes, to continue.

When I rail against price-driven mechanisms for lowering costs like high deductible insurance plans or taxing health benefits, it's because I believe greater reliance on rationing through price will create an environment where patients will increase their use of short-term economic considerations to decide what's best for their own health. Yet every study on that subject has shown that when faced with a price-driven choice, patients as often as not eliminate useful care that may not be cost-effective for the system as a whole. Indeed, the poorer you are, the more likely you are to make the wrong choice. So if health care reform legislation uses price mechanisms to control costs, the system will wind up with the worst of all possible worlds: even worse health outcomes than we already have, and more expensive health care down the road.

So, rationing? Yes. But rational rationing, not rationing borne of some ideological fascination with free market ideology inappropriately applied to health care. In the end, health care isn't a private good. It's a public good like public education, fighting fires, providing police protection or the common defense. And like any public good, relying on sovereign consumers wielding their own dollars to deliver the desired outcome will never work.

Here's another thing we have to watch for in these bills coming out of congress.